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Value of Fat Suppression in the MRI Evaluation of Suspected Arrhythmogenic Right Ventricular Dysplasia

Suhny Abbara1, Raymond Q. Migrino1, David E. Sosnovik1,2, Jeffrey A. Leichter1, Thomas J. Brady1 and Godtfred Holmvang1,2

1 Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 100 Charles River Plaza, Ste. 400, Boston, MA 02114.
2 Department of Cardiology, Massachusetts General Hospital, 100 Charles River Plaza, Ste. 400, Boston, MA 02114.



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  		Fig. 1. —Bar chart shows distribution of fat scores (n = 202) by both observers for identification of index areas using images without fat suppresion (black bars) and with fat suppression (white bars). More decisive scores of "Not Fat" and "Fat" were chosen when fat-suppressed images were available. When fat-suppressed images were not available, more indecisive scores predominated.

 


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  		Fig. 2A. —39-year-old woman with right ventricular arrhythmias. Conventional spin-echo MR image shows prominent intramyocardial high-signal-intensity changes (arrows), suggesting presence of fat.

 


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  		Fig. 2B. —39-year-old woman with right ventricular arrhythmias. Matching fat-suppressed spin-echo MR image shows signal dropout in same high-signal-intensity areas as A (arrows), confirming intramyocardial fatty infiltration.

 


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  		Fig. 3A. —53-year-old man with high density of ventricular ectopy of right ventricular origin, resulting in arrhythmia-related image degradation. Conventional spin-echo MR image shows subtle linear intramyocardial signal increase (arrows), suggestive of intramyocardial fatty infiltration.

 


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  		Fig. 3B. —53-year-old man with high density of ventricular ectopy of right ventricular origin, resulting in arrhythmia-related image degradation. Matching fat-suppressed spin-echo MR image shows no signal dropout in area corresponding to signal increase (arrows), in spite of excellent suppression of adjacent epicardial fat. This appearance suggests absence of intramyocardial fat; increased signal seen in A may be artifact.

 


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  		Fig. 4A. —61-year-old man with right ventricular arrhythmias. Conventional spin-echo MR image shows subtle linear intramyocardial high-signal-intensity changes (arrows).

 


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  		Fig. 4B. —61-year-old man with right ventricular arrhythmias. Matching fat-suppressed spin-echo MR image shows linear signal dropout in corresponding area (arrows), indicating intramyocardial fat.

 

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